Retrospective study of 19 patients with intramedullary spinal cord metastasis.
OBJECTIVE
Intramedullary spinal cord metastasis (ISCM) is a rare but devastating complication of cancer. Due to both widespread MRI availability and longer survival of cancer patients, the probability of discovering an ISCM during the course of the disease has increased and raised issues regarding the management of these patients, and particularly the place of surgery. In this study, we assess predictive factors for surgical outcome and survival.


METHODS
We retrospectively reviewed a series of 19 patients consecutively admitted in our institution from 1993 to 2006 for ISCM, representing the second largest series published in the literature. MRI was performed on all patients. Thirteen underwent microsurgical excision of ISCM. Functional outcome was evaluated and factors influencing survival were statistically analyzed.


RESULTS
Median survival was statistically longer when surgery was performed (7.4 vs. 2.6 months). Preoperative neurological status, nature of primary cancer, presence of systemic and/or CNS metastases influenced survival, but differences were without statistical significance. Neurological status improved in 58% (11/19) of operated patients.


CONCLUSIONS
Optimal management of patients with ISCM is difficult due to the wide variety of clinical situations and the lack of controlled studies on the results of different therapeutic options. Diagnosis should be made as early as possible and surgical resection should be considered as the primary treatment whenever feasible, particularly in the case of rapidly progressive neurological deficits and when a clear cleavage plane exists. Our study shows that surgery could result in both increased survival rate and significant improvement of neurological function.
Dam-Hieu
Phong
P
Department of Neurosurgery, University of Bretagne Occidentale, School of Medicine and University Medical Center, Brest, France. phong.damhieu@chu-brest.fr
Seizeur
Romuald
R
Mineo
Jean-François
JF
Metges
Jean-Philippe
JP
Meriot
Philippe
P
Simon
Hélène
H
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology; D018288:Carcinoma, Small Cell / Q000556:secondary / Q000601:surgery; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D008866:Microsurgery / Q000379:methods / Q000706:statistics & numerical data; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013120:Spinal Cord Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome